Parenteral Nutrition (PN) Safety:
Minimize the Risk for your Patients
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Overview: The American Society for Parenteral
Incorporate
these best practice
recommendations
to optimize safe and
effective PN
and Enteral Nutrition (A.S.P.E.N.) champions the best
evidence-based practices that support parenteral nutrition
therapy in varying age populations and disease states.
Approximately 350,000 patients in the U.S. receive
parenteral nutrition (PN) during hospital stays and many
more receive PN at home and in alternative care settings
(www.hcupnet.ahrq.gov). The appropriate use of this
complex therapy aims to maximize clinical benefit while
minimizing the potential risks for adverse events.
Access the parenteral
nutrition tools and
resources you need
to deliver PN
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Clinical Evidence:
Complications
can occur as a result of the therapy and
as the result of the PN process. These
consensus recommendations are based on
best practices that are generally accepted
to minimize errors with PN therapy. These
recommendations are categorized in the
areas of PN prescribing, order review and
verification, compounding, and administration.
Recommendations:
PRESCRIBING
ORDER REVIEW
COMPOUNDING
ADMINISTRATION
1. Prescribe PN using a
standardized PN order
format and review
process applicable
to patients of every
age and disease state
within a healthcare
organization
1. Avoid verbal and telephone
orders for PN, except for
pharmacist to prescriber
communication to modify or
clarify the order.
1. Provide an in-depth training
program focusing on CSPs
for all staff members
participating in the
preparation process with
an ongoing competency
assessment program.
1. Conduct ongoing validation
of competency in PN
administration.
2. Reorder PN in its entirety,
including full generic
names and doses.
3. E
ducate all prescribers,
including physicians,
pharmacists, nurse
practitioners, physician
assistants, and
dietitians, on basic
PN prescribing and
monitoring.
2. Require transcription of PN
order data to undergo an
independent double-check
process prior to compounding.
3. Develop criteria to evaluate
and identify pharmacists who
are competent to review and
verify PN orders.
4. Develop a policy and
procedure/protocol for
standardized labeling of PN
formulations.
5. Develop, communicate, and
implement protocols for PN
component substitution and/
or conservation strategies to
be used in the event of a PN
component shortage or outage.
2. Implement specific
computerized soft limits and
hard (catastrophic) limits for
PN ingredients based upon
pharmacists’ reviews that are
consistent with the needs of
their patient population.
3. Comply with USP Chapter
<797> standards.
4. Consider outsourcing as
an alternative to in-house
compounding or standardized,
commercially available PN
products when the healthcare
organization does not possess
the technological resources or
staffing to prepare PN admixtures
according to USP Chapter <797>.
2. V
isually inspect the integrity of
the PN container and formulation
before spiking the container.
3. Verify the PN label against the
original prescriber order and
avoid verbal orders.
4. Trace administration tubing to
the point of origin in the body at
the initiation of the infusion and
at all handoffs.
5. Infuse PN infusions through a
filter appropriate for the type of
formulation. Never remove an
occluded filter in response to
occlusion alarms, thus allowing
the unfiltered formulation to
continue to infuse.
6. Maintain PN infusion at the
prescribed rate using verified
correct pump settings via an
independent double check.
For full recommendations, rationale, and references, go to Ayers P, Adams S, Boullata J, Gervasio J, Holcombe B, Kraft M, et al.
A.S.P.E.N. Parenteral Nutrition Safety Consensus Recommendations . JPEN J Parenter Enteral Nutr. 2013. www.nutritioncare.org/pnsafety
A.S.P.E.N.
Parenteral Nutrition Resources
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Incorporate these best practice recommendations to optimize safe and effective PN.
ELECTRONIC (www.nutritioncare.org/pnsafety)
1. Parenteral Nutrition Safety Consensus Recommendations
2. Parenteral Nutrition Safety Webpage
3. Parenteral Nutrition Drug Shortages Webpage
PRINT
1. A.S.P.E.N. Parenteral Nutrition Handbook
2. Boullata JI, Guenter P, Mirtallo JM. A Parenteral
Nutrition Use Survey With Gap Analysis JPEN J
Parenter Enteral Nutr. 2013; 37, 2: pp. 212-222
3. M
irtallo JM. Parenteral Nutrition: Can Outcomes
Be Improved? JPEN J Parenter Enteral Nutr. 2013;
37: 181-189
EDUCATION OPPORTUNITIES
1. W
riting Parenteral Nutrition (PN) Orders Workshop
The workshop is designed to train clinicians to assess a patient requiring PN and subsequently
initiate and manage the PN therapy for that patient. The workshop is offered annually
as a preconference course prior to Clinical Nutrition Week and is limited to 40 attendees.
www.nutritioncare.org/pnworkshop
2. Clinical Nutrition Week (CNW)
CNW is A.S.P.E.N.’s annual conference and is the premier conference on clinical nutrition and
metabolism. CNW offers educational sessions for the diverse patient populations served by an
interdisciplinary audience of clinical nutrition professionals. The conference consistently offers are
educational sessions related to patient safety, including but not limited to, safe practices in PN.
www.nutritioncare.org/cnw
www.nutritioncare.org